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      Is First Trimester Maternal 25-Hydroxyvitamin D Level Related to Adverse Maternal and Neonatal Pregnancy Outcomes? A Prospective Cohort Study among Malaysian Women

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          Abstract

          Information on the role of 25-hydroxyvitamin D (25(OH)D) in preventing adverse pregnancy/neonatal outcomes is limited in Malaysia. This study aims to determine the relationship between the level of maternal 25(OH)D in the first trimester of pregnant women and their pregnancy/neonatal outcomes. A total of 60 pregnant women in the first trimester were recruited and followed until the end of their pregnancy. The occurrence of any antenatal, delivery, and neonatal complications was recorded. Their blood was collected in the first trimester for total serum 25(OH)D determination using enzyme-linked immunosorbent assay. Overall, 10% of the women had vitamin D deficiency, while 57% had vitamin D insufficiency in their first trimester. No statistically significant difference in 25(OH)D level/status was observed between women with or without antenatal and delivery complications ( p > 0.05). No difference in maternal serum 25(OH)D level and vitamin D status was observed between neonates with or without complications ( p > 0.05). In conclusion, there is a high prevalence of vitamin D insufficiency among Malaysian pregnant women, but it is not associated with adverse maternal and neonatal outcomes. More comprehensive studies should be planned to verify this relationship.

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          Most cited references36

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          Sample size calculation in medical studies

          Optimum sample size is an essential component of any research. The main purpose of the sample size calculation is to determine the number of samples needed to detect significant changes in clinical parameters, treatment effects or associations after data gathering. It is not uncommon for studies to be underpowered and thereby fail to detect the existing treatment effects due to inadequate sample size. In this paper, we explain briefly the basic principles of sample size calculations in medical studies.
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            Blood biomarkers of vitamin D status.

            J Zerwekh (2008)
            In the past quarter century, more than 50 metabolites of vitamin D have been described. To date, only a few of these have been quantified in blood, but this has widened our understanding of the pathologic role that altered vitamin D metabolism plays in the development of diseases of calcium homeostasis. Currently, awareness is growing of the prevalence of vitamin D insufficiency in the general population in association with an increased risk of several diseases. However, for many researchers, it is not clear which vitamin D metabolites should be quantified and what the information gained from such an analysis tells us. Only 2 metabolites, namely, 25-hydroxyvitamin D [25(OH)D] and 1,25-dihydroxyvitamin D [1,25(OH)2D], have received the greatest attention. Of these, the need for measuring serum 1,25(OH)2D is limited, and this metabolite should therefore not be considered as part of the standard vitamin D testing regimen. On the other hand, serum 25(OH)D provides the single best assessment of vitamin D status and thus should be the only vitamin D assay typically performed. Currently, numerous formats exist for measuring serum 25(OH)D concentrations, each with its own advantages and disadvantages. This article reviews the currently available methods for serum 25(OH)D quantitation and considers important issues such as whether both the D2 and the D3 forms of the vitamin should be assayed, whether total or free concentrations are most important, and what measures should be taken to ensure the fidelity of the measurements.
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              Vitamin D: metabolism.

              The biologically active metabolite of vitamin D, 1,25(OH)(2)D(3), affects mineral homeostasis and has numerous other diverse physiologic functions including effects on growth of cancer cells and protection against certain immune disorders. This article reviews the role of vitamin D hydroxylases in providing a tightly regulated supply of 1,25(OH)(2)D(3). The role of extrarenal 1alpha(OH)ase in placenta and macrophages is also discussed, as well as regulation of vitamin D hydroxylases in aging and chronic kidney disease. Understanding specific factors involved in regulating the hydroxylases may lead to the design of drugs that can selectively modulate the hydroxylases. The ability to alter levels of these enzymes would have therapeutic potential for the treatment of various diseases, including bone loss disorders and certain immune diseases. Copyright 2010 Elsevier Inc. All rights reserved.
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                Author and article information

                Journal
                Int J Environ Res Public Health
                Int J Environ Res Public Health
                ijerph
                International Journal of Environmental Research and Public Health
                MDPI
                1661-7827
                1660-4601
                08 May 2020
                May 2020
                : 17
                : 9
                : 3291
                Affiliations
                [1 ]Department of Obstetrics and Gynaecology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Cheras 56000, Malaysia; norhaslinda.abdaziz@ 123456ppukm.ukm.edu.my (N.H.A.A.); yanieyazid83@ 123456gmail.com (N.A.Y.); drrahana@ 123456ppukm.ukm.edu.my (R.A.R.); shimaabdrashid5@ 123456gmail.com (N.A.R.); pslim@ 123456ppukm.ukm.edu.my (P.S.L.)
                [2 ]Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Cheras 56000, Malaysia; jocylnwsk@ 123456gmail.com (S.K.W.); vaizuramohd@ 123456gmail.com (N.V.M.)
                Author notes
                [* ]Correspondence: chinkokyong@ 123456ppukm.ukm.edu.my ; Tel.: +603-9145-9573
                Author information
                https://orcid.org/0000-0003-4161-6461
                https://orcid.org/0000-0002-8043-3134
                https://orcid.org/0000-0003-1184-4551
                https://orcid.org/0000-0001-6628-1552
                Article
                ijerph-17-03291
                10.3390/ijerph17093291
                7246875
                32397276
                f487f6c1-303d-4699-a1f4-7e9f9c3bd33b
                © 2020 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 03 April 2020
                : 05 May 2020
                Categories
                Article

                Public health
                vitamin d,first trimester,pregnancy complications,neonates
                Public health
                vitamin d, first trimester, pregnancy complications, neonates

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